The use of SNOMED is referred to in several areas of the pproposed final regulations for MU criteria for EHR implementation. While we're all familiar with ICD-9-CM (and, hopefully soon to be ICD-10), we may not know as much about SNOMED. So, I thought now would be a good time to take a look at SMOMED and how CMS views its role within the EHR. SNOMED is the acronym for Systematized Nomenclature of Medicine. SNOMED is a clinical healthcare terminology that was designed for use in EHRs, not paper-based health records. It contains over 311,000 codes (and growing!) compared to the 14,000 or so codes contained in ICD-9-CM and 68,000 in ICD-10.
Here's what CMS has to say about SNOMED:
SNOMED has been in existence since 1976 and has evolved through several stages. The newest reorganization of SNOMED resulted in SNOMED Clinical Terms (SNOMED CT), which was first released in 2002. SNOMED CT is the most advanced medical terminology coding system in use anywhere. This is a good thing but its sophistication can make it challenging to understand SNOMED.
When SNOMED CT was in the planning stages a new system of codes was devised to make SNOMED fully computable. Everything in SNOMED got a new code – concepts, terms, relationships between concepts, the status of terms and concepts, etc. These new codes, called SNOMED Identifiers, are 7-9 digit numbers. Previously only SNOMED concepts had codes. There were no synonym codes, relationship codes, status codes, etc. The old SNOMED codes consisted of 1-2 letters followed by a hyphen and a string of five characters (numbers and letters). Since SNOMED had been in use for 25 years by this time and users were familiar with the codes, the old SNOMED concept codes were retained in SNOMED CT. This means everything in SNOMED CT has a new SNOMED Identifier, and concepts have both an Identifier and an old SNOMED code. Currently the PHIN NCMTs only use SNOMED for organism names and codes. For this purpose either the old SNOMED codes or the new SNOMED Identifiers can be used, and both are included in the tables. Many people prefer the old SNOMED codes because they are easier to read and remember. For computing purposes, however, the new SNOMED Identifiers are better.| SNOMED organism | SNOMED ID | SNOMED code |
| Dengue virus | 34348001 | L-32320 |
| Blastomyces dermatitidis | 65615007 | L-44171 |
| Listeria monocytogenes | 36094007 | L-20901 |
If you have an interest in learning more about the complexities of the SNOMED system, you can find it on the IHTSDO (International Health Terminology Standards Development Organization) website.
Bottom line for CDI is this.....if we thought ICD-10 was going to require more rigor and detail in documentation, SNOMED and the future of clinical terminology will change all that. True, use of SNOMED alone can improve clinical documentation. But, between now and then, there's of preparatory work to be done. And, that preparation includes developing habits of looking for and documenting details about a patient's problems and diagnoses. The futue is here.
